Cholecystitis and Gallstones Quiz

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Questions and Answers

Which of the following factors can contribute to bile stasis?

Pregnancy (correct)

Inflammatory lesions in the biliary system (correct)

Immobility (correct)

Increased bile flow

What is the most common cause of cholecystitis?

Prolonged immobility

Diabetes

Gallstones (correct)

Biliary sludge

What is the difference between acalculous cholecystitis and cholecystitis associated with gallstones?

Acalculous cholecystitis is always caused by bacterial infection.

Acalculous cholecystitis is less severe than cholecystitis associated with gallstones.

Acalculous cholecystitis is more common in younger adults.

Acalculous cholecystitis occurs in the absence of gallstones. (correct)

What is the primary cause of pain associated with gallstones?

Spasms of the biliary ducts (B) Signup and view all the answers

Which of the following is a common complication of cholecystitis?

Pancreatitis (D) Signup and view all the answers

What is the primary diagnostic tool used to identify gallstones?

Ultrasound (C) Signup and view all the answers

Which of the following is a common symptom of cholecystitis?

Abdominal tenderness (A) Signup and view all the answers

How does obstruction of the common bile duct affect bilirubin levels?

Increased bilirubin levels in the urine (B) Signup and view all the answers

What is the primary treatment modality for symptomatic gallstones?

Laparoscopic cholecystectomy (A) Signup and view all the answers

Which of the following is NOT a contraindication to laparoscopic cholecystectomy?

Mild obesity (A) Signup and view all the answers

Which of the following treatment options is typically used to treat symptomatic gallstones?

Cholecystectomy (C) Signup and view all the answers

What is the role of cholecystokinin in the context of the gallbladder?

Stimulates gallbladder contraction (D) Signup and view all the answers

What is the purpose of a T tube placed in the common bile duct during a common bile duct exploration surgery?

To keep the duct patent until edema subsides (A) Signup and view all the answers

What is the primary treatment goal during an acute episode of cholecystitis?

Pain control, infection control, and fluid/electrolyte balance (B) Signup and view all the answers

Which of the following medications is commonly used to relax smooth muscle and decrease ductal tone in gallbladder disease?

Anticholinergics (C) Signup and view all the answers

What type of diet is recommended for patients with chronic gallbladder disease?

Low-saturated fat diet (A) Signup and view all the answers

What is transhepatic biliary catheterization used for?

Decompression of obstructed bile ducts (B) Signup and view all the answers

Which of the following is a common complication after laparoscopic cholecystectomy?

Injury to the common bile duct (A) Signup and view all the answers

What is the primary purpose of ERCP?

Visualization and treatment of the biliary system (A) Signup and view all the answers

Which of the following procedures might be used to drain purulent material from an obstructed gallbladder?

Cholecystostomy (D) Signup and view all the answers

Which of these is a condition that can contribute to the formation of gallstones?

Decreased bile acid production (C), Increased mucus production (D) Signup and view all the answers

Which of the following is NOT a known risk factor for gallbladder disease?

High protein diet (C) Signup and view all the answers

What is the most common type of gallstone?

Mixed cholesterol stones (A) Signup and view all the answers

What medical condition is characterized by inflammation of the gallbladder wall?

Cholecystitis (A) Signup and view all the answers

What is the term used for the surgical removal of the gallbladder?

Cholecystectomy (B) Signup and view all the answers

What is the primary factor that contributes to gallstone formation in terms of bile composition?

Supersaturation of bile with cholesterol (D) Signup and view all the answers

Which demographic group has a particularly high incidence of gallbladder disease?

Native Americans (B) Signup and view all the answers

Based on the provided information, what is the most common symptom associated with gallbladder disease in many individuals?

Lack of symptoms (C) Signup and view all the answers

If a person has gallstones, what is the most common location for them to lodge within the biliary system?

Cystic duct (D) Signup and view all the answers

Which of the following is NOT a factor that can contribute to gallbladder dysmotility and stasis, potentially leading to gallstone formation?

Rapid emptying of the gallbladder (B) Signup and view all the answers

What is a common symptom experienced by a patient with acute cholecystitis or gallstones?

Nausea (C) Signup and view all the answers

What nursing intervention is most helpful in managing a patient with severe nausea and vomiting related to acute cholecystitis?

Inserting a nasogastric tube (C) Signup and view all the answers

What is a common complication to monitor for after an ERCP with papillotomy?

Pancreatitis (B) Signup and view all the answers

Which of the following signs or symptoms may indicate obstruction of the bile ducts by gallstones?

Clay-colored stools (D) Signup and view all the answers

What is a nursing intervention to address referred shoulder pain after a laparoscopic cholecystectomy?

Positioning the patient on the left side with right knee flexed (D) Signup and view all the answers

What is a key element of patient education for a patient who has had a laparoscopic cholecystectomy?

The importance of continued healthcare follow-up (A) Signup and view all the answers

What is a common dietary recommendation for a patient with chronic cholecystitis?

Low-fat diet (D) Signup and view all the answers

What is the primary purpose of a T-tube after an incisional cholecystectomy?

To drain bile from the gallbladder (D) Signup and view all the answers

Which of the following is NOT a common predisposing factor for gallbladder disease?

Hypertension (A) Signup and view all the answers

What type of nursing care is essential for a patient with acute cholecystitis who is receiving conservative therapy?

Monitoring for signs of infection (D) Signup and view all the answers

Study Notes

Cholelithiasis and Cholecystitis

Cholelithiasis: A common biliary system disorder, characterized by gallstones that may lodge in the gallbladder neck or cystic duct. Often associated with cholecystitis.
Cholecystitis: Inflammation of the gallbladder wall, frequently caused by gallstones. Can be acute or chronic.
Prevalence: Gallbladder disease is common in the US, affecting up to 10% of American adults with gallstones. Many cases are asymptomatic.
Risk Factors (Cholelithiasis): Women are more prone to gallstones, especially multiparous women and those over 40. Postmenopausal women on estrogen therapy and younger women on oral contraceptives are also at increased risk. Sedentary lifestyle, family history, and obesity also contribute. Obesity increases cholesterol secretion in bile. Native Americans have a high incidence.

Etiology and Pathophysiology of Cholelithiasis

Cause: The exact cause of gallstones is unknown. Gallstones form when the balance of cholesterol, bile salts, calcium, bilirubin, and protein in bile is disrupted, causing precipitation.
Types: Mixed cholesterol stones are the most common type, primarily composed of cholesterol.
Formation Factors: Factors contributing to gallstone formation include: supersaturation of bile with cholesterol; decreased bile acids necessary to dissolve cholesterol; excess mucus production; gallbladder dysmotility (problems with movement) or stasis (slowed flow).
Mechanism: The liver excretes cholesterol into bile. If the liver excretes more cholesterol than the bile can dissolve, crystals form, leading to gallstones. Lithogenic bile refers to bile supersaturated with cholesterol. Bile stasis in the gallbladder promotes stone formation and changes in bile composition (biliary sludge). Factors like immobility, pregnancy, and biliary system issues decrease bile flow. Pregnancy's hormonal changes lead to gallbladder emptying delay, promoting stasis.

Cholelithiasis Progression and Complications

Migration: Gallstones may remain in the gallbladder or migrate to the cystic duct or common bile duct. Migration causes pain as stones pass through ducts.
Obstruction: Small stones are more likely to block a duct. Complete common bile duct blockage leads to decreased bilirubin reaching the small intestine for conversion to urobilinogen. Kidneys excrete bilirubin, causing dark urine. Cystic duct obstruction allows bile to flow directly from liver to duodenum, but gallbladder bile stasis leads to cholecystitis.
Cholecystitis & Acalculous Cholecystitis: Often associated with obstruction (gallstones or biliary sludge). Acalculous occurs in older adults, critically ill, individuals with prolonged immobility, prolonged parenteral nutrition, or diabetes, usually due to bile stasis. Critically ill patients are at risk due to increased bile viscosity or lack of cholecystokinin-induced gallbladder contraction.
Infection: Secondary infection is common in acalculous cholecystitis. Enteric pathogens are involved (E. coli, Enterococcus faecalis, Klebsiella, Pseudomonas, Proteus). Sever cholecystitis can perforate.

Cholecystitis: Inflammation Details

Inflammation: Inflammation is central. It can range from affecting only the lining to involving the entire gallbladder wall. Inflamed gallbladders become edematous and hyperemic, potentially filled with bile or pus.
Cystic Duct Involvement: Cystic duct involvement is common, leading to occlusion.
Scarring: The gallbladder wall becomes scarred after acute attacks, leading to decreased function if significant tissue fibrosis occurs.

Clinical Manifestations & Diagnosis

Symptoms: Gallstones can range from asymptomatic to severely painful (biliary colic), usually steady pain, accompanied by tachycardia, diaphoresis, and prostration. Pain often occurs after a high-fat meal or when lying down. Total obstruction (common bile duct blockage) results in bile duct-related symptoms (listed in Table 48.22).
Cholecystitis Symptoms: Symptoms range from indigestion to severe pain, fever, chills, and jaundice; Initial signs are indigestion, acute pain, and RUQ tenderness. Pain may radiate to the right shoulder and scapula. Other symptoms can include nausea, vomiting, restlessness, diaphoresis, fever and increased WBC count.
Chronic Cholecystitis Symptoms: A history of fat intolerance, dyspepsia, heartburn, and flatulence may suggest chronic cholecystitis.
Diagnosis Tools: Ultrasound is often used for initial gallstone diagnosis. Endoscopic Retrograde Cholangiopancreatography (ERCP) visualizes the biliary system. Percutaneous transhepatic cholangiography involves inserting a needle into the gallbladder duct. Lab tests show increased WBC count, liver enzymes (alkaline phosphatase, ALT, AST), bilirubin (direct & indirect), and urinary bilirubin (obstruction). Increased amylase/lipase suggests pancreatic involvement.

Interprofessional Care: Treatment

Conservative Therapy: Cholesterol-solvent drugs (ursodiol, chenodiol) dissolve stones, but recurrence is possible. Gallstones are usually treated surgically.
ERCP: Endoscopic procedures like ERCP with sphincterotomy/papillotomy remove stones, provide biliary system visualization, and dilate/place stents.
Lithotripsy (ESWL): A shock wave therapy (ESWL) disintegrates stones suitable for endoscopic access to smaller fragments passing into the intestine.
Cholecystitis Acute Care: Pain control, antibiotics (infection control), and maintain fluids/electrolytes. NG tube/gastric decompression may be used for severe nausea/vomiting. May use cholecystostomy to drain purulent material from gallbladder. Opioids and Anticholinergics may be used.
Surgical Therapy: Laparoscopic cholecystectomy is the preferred approach (90%). Minimally invasive, with small incisions, CO2 insufflation for better visualization. Open (incisional) cholecystectomy is for contraindications (e.g., peritonitis, serious bleeding disorders).
T-tube (incisional cholecystectomy): A T-tube may be placed in the common bile duct for temporary drainage, preventing closure and keeping the duct open.
Transhepatic Biliary Catheter: Used in obstructive jaundice/biliary obstruction or for palliative care (in cancer cases).

Postoperative Care and Ambulatory Care

Laparoscopic: Post-op includes pain management (sometimes referred shoulder pain from CO2), deep breathing, pain meds, liquid diet, return to normal activity within a week.
Incisional: Requires monitoring for incisional issues, and return to normal diet after adequate bowel sounds. Avoid heavy lifting for a timeframe.
Ambulatory Care (Conservative Therapy): Includes diet teaching (low-fat diet and fat-soluble vitamin supplements), weight management, follow-up support.
Ambulatory Care (Post-Surgical): Diet instruction (low-fat, if necessary), weight management, follow-up appointments. No heavy lifting, sexual activity as tolerated after incisional procedure.

Nursing Management and Evaluation

Assessment: Subjective and Objective data are crucial (Table 48.24).
Clinical Problems: (during/after procedures) Pain, impaired GI function.
Goals: Goals include pain/discomfort relief, prevention of complications and recurrent attacks.
Health Promotion: Identifying predisposing factors to gallbladder disease in health screenings and supporting healthy habits. Teaching patients how to observe symptoms.
Acute Care: Pain relief, nausea/vomiting management, comfort, fluid/electrolyte/nutrition maintenance, complication monitoring.
Post-op Care: Monitoring for complications (e.g., bleeding, respiratory issues), comfort, discharge planning. Monitoring T-tube drainage if applicable.

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Description

Test your knowledge on cholecystitis and gallstones with this quiz. It covers causes, symptoms, diagnostic tools, and treatment options related to these conditions. Dive into the complexities of biliary system disorders and enhance your understanding of gallbladder health.